Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan-Dec:10:23247096211058490.
doi: 10.1177/23247096211058490.

Superior Divisional Palsy of the Oculomotor Nerve as a Presenting Sign of SARS-CoV-2 (COVID-19)

Shrestha Prajwal  1 , Achebe Ikechukwu  1 , Sharma Bharosa  1 , Mba Benjamin  1
Affiliations
Case Reports

Superior Divisional Palsy of the Oculomotor Nerve as a Presenting Sign of SARS-CoV-2 (COVID-19)

Shrestha Prajwal et al. J Investig Med High Impact Case Rep. 2022 Jan-Dec.

Abstract

Although COVID is a predominantly respiratory disease, recent studies demonstrate variable and atypical presentations with multiorgan involvement. Neurological manifestations involving cranial nerves and the peripheral nervous system are more frequently being described. Although mechanisms are still under investigation, several studies demonstrate the neuroinvasive potential of COVID via angiotensin-converting enzyme 2 (ACE2) receptor interactions and postulate this mechanism to be the route of COVID central nervous system (CNS) infection. We present the rare case of a purely superior divisional palsy of the left oculomotor nerve in a 46-year-old woman with no medical history in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, confirmed by magnetic resonance imaging (MRI) findings of asymmetrical thickening and enhancement of the left oculomotor nerve. With this report, we hope to increase clinical suspicion for oculomotor nerve palsies as a manifestation of SARS-CoV-2 infection and also to inspire further studies investigating neurological manifestations of COVID.

Keywords: COVID; Oculomotor nerve palsy; cranial nerve; diplopia; neurology.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
MRI Brain and Orbits showing asymmetrical thickeing and enhancement of the left oculomotor nerve.
See this image and copyright information in PMC

References

    1. Sarria -Guzmán Y, Fusaro C, Bernal JE, Mosso-González C, González-Jiménez FE, Serrano-Silva N. Knowledge, Attitude and Practices (KAP) towards COVID-19 pandemic in America: a preliminary systematic review. J Infect Dev Ctries. 2021;15(1):9-21. - PubMed
    1. Huang C, Wang Y, Li X, Ren L, et al.. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. - PMC - PubMed
    1. Mao L, Jin H, Wang M, et al.. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. - PMC - PubMed
    1. Bhatti MT, Eisenschenk S, Roper SN, Guy JR. Superior divisional third cranial nerve paresis: clinical and anatomical observations of 2 unique cases. Arch Neurol. 2006;63(5):771-776. - PubMed
    1. Çelebisoy N, Çelebisoy M, Tokuçoǧlu F, Ozdemir I. Superior division paresis of the oculomotor nerve: report of four cases. Eur Neurol. 2006;56(1):50-53. - PubMed

Publication types